Healthcare Provider Details

I. General information

NPI: 1164512216
Provider Name (Legal Business Name): WILLIAM SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date: 02/09/2018
Reactivation Date: 03/06/2018

III. Provider practice location address

4021 S 700 E SUITE 300
SALT LAKE CITY UT
84107-2192
US

IV. Provider business mailing address

413 NORWICK PLACE
BLUE BELL PA
19442
US

V. Phone/Fax

Practice location:
  • Phone: 800-453-3030
  • Fax:
Mailing address:
  • Phone: 215-699-1934
  • Fax: 215-699-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number026921L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: